Returning to Full Speed After ACL Surgery
Gary Gray, one of my biggest influences in terms of how I think about training, uses his front yard/back yard analogy to describe situations like ACL injury prevention. When you’re raising kids, it’s safer to keep them in the back yard than it is to let them play in the front where the road is. But then again, is it safer? What happens when they end up in the front yard, unsupervised, with cars zipping by? After all, life is pretty good at throwing us the occasional curveball, ready or not. If they’ve never been there and don’t really know what to do, have we done them a favor or a disservice by keeping them safe in the back yard?
That’s how we look at training the knee to be truly ready to return to play. At some point, you have to put the knee in positions where it is at a mechanical disadvantage. In the backyard, we can land quietly with the feet parallel, the shoulders forward, and the hips back. But what happens when in the heat of battle we’re going up for a rebound that requires the trunk and hips to be extended and the player to land primarily on one leg with only the knee to cushion the impact? Those perfect landing mechanics are pretty useless in that situation.
Now we’re not advocating taking someone straight into these dangerous patterns right off the bat. In fact, it’s quite the opposite. We start every post-rehab client the same way – demonstrating mastery of the easy stuff first. They need to show that they have both the mobility they need and the motor control of that mobility. They need to be able to perform at low speeds before they work at higher speed. They need to be proficient in low force situations before they progress to high force situations. They need to function well with advantageous body positions before progressing to disadvantageous body positions. They need to be able to handle the more challenging patterns fresh before they handle them in a fatigued state. And there are, of course, limits to how far we’ll take this, but we’ll set those limits on an individual basis.
Here are a few examples of how we might progress from easier to harder demonstrated by Robert, one of our ACL rehab athletes. For a little background, Robert came to us after his 3rd ACL surgery 18 months ago. The exercises you see here were a long time coming and now represent the maintenance work that he does now to keep his knee functioning at a high level.
Progression 1 – Low force, multiple vectors
Progression 2 – Multiple vectors, increased force, external loads
Progression 3 – Multiple vector jump progression
This process takes weeks, if not months, rather than minutes, but the important thing is that the process gets started early and you prepare the knee for the forces, angles, and speeds that it’s going to need to handle in the game. You’ll never be truly “back” at full speed with the hesitation and doubt that comes when you’re not certain that your knee is ready for whatever comes it’s way.
Do you have an recent or old ACL-injured knee that’s just not quite right or is keeping you from doing what you love to do? We’d love to hear from you!